Lower LDL-c/ApoB ratio is associated with adverse cardiovascular outcomes and advanced peripheral artery disease

Summary: Background: Apolipoprotein B (ApoB) levels and low-density-lipoprotein-cholesterol (LDL-c)/ApoB ratio have emerged as potential more accurate markers of cardiovascular (CV) risk, than LDL-c concentration alone. However, prognostic values in predicting CV outcomes, including major adverse cardiac and limb events (MACE and MALE) in peripheral artery disease (PAD) remains to be elucidated. Aim is to assess weather correlations exist between lipid parameters and PAD outcomes. Patients and methods: Consecutive PAD patient’s first visit data from the Peripheral ARTEry Disease (PARTED) registry (2022–2024) were analysed. Demographic, clinical variables, and lipid parameters (LDL-c, Lp(a) and ApoB concentrations) were collected at time of inclusion. PAD patients were stratified in tertiles based on LDLc/ApoB ratio values. MACE and MALE outcomes arising prior to study inclusion were evaluated. Multivariate logistic regression analysis was performed. Results: A total of 339 chronic PAD patients were included. M age was 71 years, 68% were males. M LDL-c concentration was 1.9 mmol/L, and only 27% of patients were on target (LDL-c ≤ 1.4 mmol/L). Significant association with prior MACE was found in the lowest and intermediate LDL-c/ApoB tertile group (low: OR 2.09, C-I 1.04–4.21, p < .05; intermediate: OR 2.06, C-I 1.04–4.09, p < .05) while no significant association was found between past MACE and LDL-c or ApoB tertiles. Conclusions: Lower LDL-c/ApoB ratios (LAR) remained associated with prior MACE after multivariable adjustment, highlighting the importance of a comprehensive lipid profile assessment. Whether LAR tracks with treatment intensification or retains associative value with historical events needs to be clarified.